All Vision but No Change? Determinants of Implementation: The Case of Ireland and Mental Health Policy

What the book is about

Many acclaimed policies in Ireland have failed to deliver on their aspirations, leading some commentators to talk of a problem of implementation. The failure to fully implement some public service policies has led to frustrations on the part of policymakers, service providers and service users alike. All Vision but No Change? Determinants of Implementation: The Case of Ireland and Mental Health Policy reviews the implementation literature from a number of perspectives. There are those who seek to implement policy from the 'top down'. Others seek to influence the implementation of policy from the 'bottom up'. Some seek to bring about implementation through change.

The mental health policy A Vision for Change is taken as a case study. The content of reports of an Independent Monitoring Group is analysed. Interviews are undertaken with people associated with implementation of the policy. These include politicians, public servants, mental health professionals, mental health service users and mental health advocates.

The key finding is that two factors were found to be fundamental to successful implementation: (1) authoritative, accountable leadership; and (2) identifying and addressing the main resisters to change. Many other factors were found to be important to some extent.

All Vision but No Change? Determinants of Implementation: The Case of Ireland and Mental Health Policy concludes that there is a need to acknowledge issues 'below the surface', including beliefs, values and power relationships in implementing policies. Innovation and creativity, along with local leadership, are important but on their own they are not enough to ensure successful implementation. 

These findings have relevance for the implementation of nationally designed policies which are intended to be implemented across the country in an even-handed way.

Contents

1. Introduction
   Rationale for the research
   Inititial insights from the Irish public service
   Empirical study
   Results
   Structure of the Book
    
2. Implementation Concepts
   An introduction to the implementation and organisational change literature
   Definition of policy implementation
   A landmark study
   Top-down approach
   Bottom-up approach
   Synthesis approaches
   Summary of implementation approaches
   Transformative factors
   Inferences from the implementation literature
   Lines of enquiry put forward for investigation
   Common factors
   Application of lines of enquiry
    
3. An Overview of Mental Health Policy in Ireland
   Why mental health poliy?
   The International context for mental health policy
   Implementation of A Vision for Change
    
4. An Analysis of the Implementation of the  Mental Health Policy A Vision for Change
   Introduction
   Overview of documentary content analysis results
   Analysis of interview findings
   View of the policy A Vision for Change
   Views on the ‘Implementation’ section of the policy
   The actual implementation of the policy
   What was implemented well?
   What was not implemented well?
   What is needed to have a modern mental health system?
   Examples of policies which have been implemented well
   Summary of key findings
    
5. A Discussion of the Determinants of Implementation
   Introduction
   Driving Policy implementation from the top down
   Influencing policy implementation from the bottom up
   Influencing policy implementation common factors
    
6. Conclusions
   Introduction
   The relative importance of the key determinants of implementation
   Relevance to the implementation literature
   Limitations of the study and the potential for further research
   Final word

Appendix A: Study Methodology
Appendix B: Summary of the Research Proposal
Appendix C: Interview Schedule
Appendix D: Summary of Content Analysis Findings
Bibliography
Index